Steroid Induced Gastrointestinal Perforation in a Traumatic Injury. Atypical Complication to a Common Drug

Abstract

We report this case of a male patient with cervical spine injury following shallow water diving. With power of 3/5 in all 4 limbs and grade 2 subluxation (C5/C6) the patient was operated on undergoing a 360 degree fixation and unlocking of facets; he was administered steroids and developed abdominal distention. An eventual CT scan showing a pneumoperitoneum revealed he had developed a gastrointestinal perforation. GI perforation is a less well recognized side effect of steroids. It can be difficult to diagnose, as the steroids can mask the symptoms of gut perforation by reducing the clinical expression of peritonitis, and a serious complication; been reported in the literature to have a mortality ranging from 27% to a 100%.1-3 We report this case as a clinical reminder of the risk of GI perforation from steroid use and to emphasize the role of a multi-disciplinary team in the management of trauma patients.